title: A multi-country study of the "intrapartum stillbirth and early neonatal death indicator" in hospitals in low-resource settings.
abstract: OBJECTIVE
  To determine the feasibility of introducing a simple indicator of quality of obstetric and neonatal care and to determine the proportion of potentially avoidable perinatal deaths in hospitals in low-income countries.
  
  
  METHODS
  Between September 1, 2011, and February 29, 2012, data were collected from consecutive women who were admitted to the labor ward of 1 of 6 hospitals in 4 low-income countries. Fetal heart tones on admission were monitored, and demographic and birth data were recorded.
  
  
  RESULTS
  Data were obtained for 3555 women and 3593 neonates (including twins). The doptone was used on 97% of women admitted. The overall perinatal mortality rate was 34 deaths per 1000 deliveries. Of the perinatal deaths, 40%-45% occurred in the hospital and were potentially preventable by better hospital care.
  
  
  CONCLUSIONS
  The results demonstrated that it is possible to accurately determine fetal viability on admission via a doptone. Implementation of doptone use, coupled with a concise data record, might form the basis of a low-cost and sustainable program to monitor and evaluate efforts to improve quality of care and ultimately might help to reduce the in-hospital component of perinatal mortality in low-income countries.
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University, NY 10032, USA. rlg88@columbia.edu
authors.forename: Robert L
authors.initials: RL
authors.lastname: Goldenberg
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: McClure
authors.forename: Bhala
authors.initials: B
authors.lastname: Kodkany
authors.forename: Gilbert
authors.initials: G
authors.lastname: Wembodinga
authors.forename: Omrana
authors.initials: O
authors.lastname: Pasha
authors.forename: Fabian
authors.initials: F
authors.lastname: Esamai
authors.forename: Antoinette
authors.initials: A
authors.lastname: Tshefu
authors.forename: Archana
authors.initials: A
authors.lastname: Patel
authors.forename: Hillary
authors.initials: H
authors.lastname: Mabaye
authors.forename: Shivaparasad
authors.initials: S
authors.lastname: Goudar
authors.forename: Sarah
authors.initials: S
authors.lastname: Saleem
authors.forename: Manjushri
authors.initials: M
authors.lastname: Waikar
authors.forename: Ana
authors.initials: A
authors.lastname: Langer
authors.forename: Carl L
authors.initials: CL
authors.lastname: Bose
authors.forename: Craig E
authors.initials: CE
authors.lastname: Rubens
authors.forename: Linda L
authors.initials: LL
authors.lastname: Wright
authors.forename: Janet
authors.initials: J
authors.lastname: Moore
authors.forename: Ann
authors.initials: A
authors.lastname: Blanc
mesh_terms: D003906:Developing Countries; D005240:Feasibility Studies; D005260:Female; D005313:Fetal Death / Q000453:epidemiology* / Q000517:prevention & control; D005318:Fetal Heart / Q000502:physiology; D005323:Fetal Monitoring / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D011247:Pregnancy; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D050497:Stillbirth / Q000453:epidemiology*
keywords: Doptone; Fetal heart tones; Hospital-based perinatal mortality; Neonatal mortality; Perinatal mortality; Stillbirth